As a researcher and psychologist studying body image for nearly 30 years, I have collaborated with doctors, psychologists, dietitians, social workers, educators, activists, and journalists. These different professionals, embedded in very different contexts, tend to describe bodies—in particular, their size—differently. In medical settings, the terms “obese”** *** or “person with obesity” are commonly used, while body-image researchers often use terms like “relatively thin” and “higher weight.” As I work across settings, I often find myself pausing over the terminology I should use. That uncertainty reflects a cultural and scientific landscape in which language has evolved, research findings are sometimes misapplied, and lived experience does not always line up with clinical convention.

The words we use to describe body size are rarely neutral. Research consistently shows that language shapes how people feel about themselves, how much weight bias they internalize, their motivation to engage in health behaviors, and even the quality of communication in clinical settings. Like descriptors for race, ethnicity, gender, or disability, the words we use for body size have changed over time, and will likely continue to change. What once seemed acceptable may later feel outdated or even harmful. The last thing I ever want to do is offend someone—especially when my objective is to educate, support, and reduce stigma. Yet what is recommended in professional guidelines is often inconsistent with what research actually reveals about people’s preferences and emotional responses to weight-related language.

So how did we get here?

A Brief History: The Rise of the “Obesity Epidemic”

When I started graduate school in the 1990s, the phrase “the obesity epidemic” was just beginning to dominate public health discourse. I had gone to graduate school to study body image and eating disorders, but it quickly became clear that most funding opportunities were earmarked for research on “obesity.” The framing was stark: People could be “overweight” or “obese,” and both categories were viewed as inherently unhealthy conditions that needed to be fixed.**

That language did not emerge in a vacuum. It was embedded in a medical model that treated higher body weight as a disease state and assumed that weight loss was the primary—or even the only—legitimate health goal. Unsurprisingly, many people did not take kindly to being labeled “overweight” or “obese,” terms that carried strong moral and aesthetic judgments alongside their clinical definitions.

The Rise of Person-First Language

In response, researchers and clinicians turned to person-first language. Rather than calling someone “obese,” they began using phrases such as “a person with obesity.” The intention was to foreground the person rather than define them by a single characteristic, following the logic used in other areas of medicine: A person has diabetes, or a person has cancer—and, therefore, a person has obesity.

In theory, this shift was meant to reduce stigma. In practice, it has often felt awkward, artificial, and surprisingly ineffective at changing attitudes. Regarding what the body mass index (BMI) categorizes as “overweight” or “obese,” person-first language also rests on a deeply contested premise—that higher body weight is best understood as an “illness.” Many people push back against this medicalization of size, asking a reasonable question: What if some people simply come in different shapes and sizes? Is this entirely different from deciding that it would be a medical problem that my shoe size is a 7.5 while someone else’s is a 9?

Despite these critiques, person-first language (“person with obesity”; “person living with obesity”) remains the preferred standard in many medical and professional settings. Clinical guidelines and systematic reviews emphasize using terms such as “person with obesity,” with the explicit goal of reducing stigma and improving patient-provider communication. Yet there is a growing disconnect between what guidelines recommend and what people themselves say they want to be called.

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What Recent Research on Preferences Actually Shows

Over the past decade, researchers have begun to ask a simple but long-overdue question: What language do people in larger bodies actually prefer?

The answer: It depends.

A recent study by Robbins and colleagues (2025) examined terminology preferences among people in larger bodies and found substantial variation linked to health beliefs, body attitudes, and political identity. Medicalized terms such as “obese” were among the least preferred for many participants, while neutral or reclaimed terms like “in a larger body” or “fat” were more acceptable in some groups. These findings challenge the assumption that person-first medical language is always the most affirming or least stigmatizing option.

A relatively recent, large study revealed somewhat similar results: Adults living with higher body weight rated relatively neutral terms—such as “weight,” “unhealthy weight,” and “overweight”—as preferred. By contrast, terms like “fat” and “super-obese” (who came up with that?!) were more likely to evoke sadness or anger, especially when used by healthcare professionals and when providers were describing children’s bodies to their parents.

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Importantly, context matters. Some people have actively reclaimed the word “fat” as a political identity and a form of resistance against stigma. Within fat acceptance and body liberation communities, “fat” can function as a neutral descriptor rather than an insult (i.e., you can be fat, thin, tall, short, blue- or brown-eyed, and these are all descriptive terms). But that reclaimed meaning does not translate seamlessly into medical or mainstream contexts, and it certainly does not apply universally. In fact, in some medical settings, “fat” refers strictly to adipose tissue and isn’t an adjective at all. In other words, there may not be a single “right” term that works for everyone, in every setting.

This Is More Than Semantics

It may be tempting to dismiss all of this as political correctness or linguistic nitpicking. But the evidence suggests otherwise. Language shapes behavior. Studies show that stigmatizing or pathologizing terminology can increase internalized weight bias, reduce trust in healthcare providers, and make people less likely to seek medical care. Even subtle shifts in wording can influence how supported or judged a person feels in a clinical encounter.

There is also a practical dimension. When clinicians use language that patients experience as shaming or dehumanizing, conversations about health behaviors become more strained and less productive. People often become less open, less engaged, and more likely to dismiss the medical advice offered. Conversely, when people feel respected and heard, they are more likely to participate in collaborative care and to discuss health concerns honestly.

What Should We Say?

The most defensible answer, based on both research and lived experience, is: It depends on the person. Here are some suggestions, based on my review of recent research:

• Ask, don’t assume. When possible, ask individuals what terms they prefer to describe their bodies or weight. This simple step avoids imposing a one-size-fits-all solution.
• Avoid moralizing or pathologizing language. Terms that imply personal failure, illness, or abnormality should be avoided.
• Be attentive to context. Words reclaimed in activist or community settings may not necessarily feel affirming in other settings, such as medical or institutional ones.

For clinicians, it is worth remembering that following guidelines is not the same as practicing person-centered care, which respects and responds to the individual person’s values, preferences, needs, and lived experience. True respect involves not only awareness of the “recommended” terms, but also remaining open to correction and feedback from the people those terms are meant to describe. What the research makes clear is that no single terminology will satisfy everyone. Instead, if our goal is to truly understand, support, and care for others, we must remain flexible, humble, and attentive to people’s lived experiences.

* I use the terms “obese,” “obesity,” and “overweight” in quotation marks as they are not my preferred terms. I am referring to them in historical and clinical context, as they have been used, but not as I believe they should presently be used.

** This is not a framing I agree with, but that is a discussion for a different day.